The Gender Gap in Healthcare
By Linda Hepler
You might be wondering, as I was, why — in this age of high-tech medicine, laser surgery, magnetic-resonance imaging, and stem-cell research — scientists have only recently started to appreciate sex/gender differences in health and healthcare. The reason is that up until the 1990s women were not routinely included in clinical-research studies that might have dispelled the erroneous belief that men and women’s bodies were identical, save for their reproductive organs. Excluding women from these studies was not intended as a slight but as a protective measure after two seminal medical events.
In the late 1950s and early 1960s thousands of seriously deformed babies were born to mothers who early in pregnancy had taken a sedative medication called thalidomide. And in the early 1970s some of the offspring of women who had taken a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriage were found to have a higher rate of genital abnormalities and cancers. Although neither of these incidents was related to drugs used during clinical research, the events were catastrophic enough to trigger policies discouraging the participation of women of childbearing age in such clinical trials until evidence of a drug’s safety during pregnancy had been established.
Decades later it became obvious that there were many unanswered questions related to sex/gender and health – puzzles that could only be solved through research. At that point both the Food and Drug Administration and the National Institutes for Health took steps to correct the lack of research and information about women. Nowadays, policies for clinical research supported by NIH mandate the inclusion of women of all ages in studies, so long as the potential results won’t cause harm, to determine if sex/gender differences exist.
Although ongoing research will undoubtedly reveal new information about primary health differences between men and women, certain areas of dissimilarity have already been established.
Cardiovascular: Cardiovascular diseases – including strokes, congestive heart failure, heart attacks, angina pectoris (chest pain caused by decreased blood supply to the heart), and cardiac arrest – are the leading cause of death in the United States. CVD is often thought of as a “man’s disease.” Yet according to the Society for Women’s Health Research since 1984, more women than men die of CVD each year. Some of the differences in how men and women experience CVD are:
Women suffer a first heart attack about 10 years later than men do, and are more likely than men to have a second heart attack within a year of the first one. Women may experience different symptoms of a heart attack than a man. While chest pain is the most common symptom of a heart attack in men, women sometimes experience more subtle discomforts in the arms, back, neck, jaw, or stomach, as well as nausea, light-headedness, or shortness of breath.
Cigarette smoking has a more negative effect on a woman’s heart than on a man’s heart.
“Metabolic syndrome,” a combination of high blood pressure, high blood glucose, and high triglycerides, plays a bigger role in the development of CVD in women than in men.
Depression and anxiety increase the risk of cardiac arrest and cardiac death in women.
Men are more likely than women to have been physically exerting themselves before a cardiac arrest.
Mental Health: Women are more likely to suffer from depression and anxiety disorders than men, but men are more likely to have substance-abuse disorders and antisocial behavior problems than women. Women make more suicide attempts than men – though men die by suicide more frequently than women.
Autoimmune Disease: Nearly 79 percent of those with autoimmune diseases (diseases in which the body’s immune system begins to attack healthy tissue) are women. Two of these diseases, rheumatoid arthritis and multiple sclerosis, affect women two to three times more frequently than men. Another, systemic lupus erythematosus, is seen in nine women for every one man. There are also differences in the course of these conditions. While women with multiple sclerosis develop symptoms more quickly after onset, men decline more rapidly.
Osteoporosis: Although men do develop osteoporosis, or loss of bone mass, 80 percent of those with this condition are women.
Smoking and Respiratory Conditions: Cigarette smoking appears to be more harmful to women, who have a higher prevalence of respiratory conditions related to smoking, such as chronic obstructive pulmonary disease. Studies are divided as to whether women are more susceptible to tobacco carcinogens – and lung cancer – than men. But women do have a harder time quitting smoking than do men, and are more likely to relapse within the first year. Nicotine replacement systems (such as patches or gum) are less likely to reduce cravings for cigarettes in women.
Alcohol: Women’s bodies produce less of the stomach enzyme that breaks down alcohol, so they have higher blood alcohol levels after drinking the same amount of alcohol as a comparably sized man. Women may also progress to addiction more quickly than men, given the same level of consumption.
STDs: Women are more likely to contract a sexually transmitted disease than men, and if they contract HIV, the virus often progress more rapidly to full-blown AIDS.
Drugs: Medications, whether over-the-counter or prescription, cause different reactions and side effects in men and women. Certain pain medications, called kappa-opiates, for example, are relatively ineffective in relieving pain in men – yet work beautifully for women. And medications for anesthesia cause additional drowsiness in men, who tend to wake up more slowly after surgery than women do.
In spite of the fact that we are continually learning more about how sex/gender differences affect our health, the challenge remains to convert clinical research into practice. Many health-care providers lack the knowledge and understanding necessary to provide gender-specific, appropriate health care. A recent national survey administered by the American Heart Association to 500 physicians revealed, for example, that fewer than one in five were aware that more women than men die each year from CVD. Numerous other studies have concluded that women receive suboptimal CVD preventive care overall, which translates into worse health outcomes than is customary with men.
Men, too, may experience poor health outcomes related to gender bias. Many men feel that health is a woman’s business, largely because health-promotion messages are often directed toward women. And men may feel they are expected to live up to stereotypical ideas of masculinity and toughness, making it particularly difficult for them to reach out for health care. One recent study found that among men and women with similar severity asthma, women were more than one and a half times as likely as men to seek emergency-room care – and be admitted to the hospital. Study authors concluded that this is because men do not perceive their asthma symptoms to be as severe as women do.
One thing about sex and gender issues related to health is certain though: As research continues to heighten our awareness of our biological and social differences, health providers will be better equipped with the tools they need to prevent, diagnose, and treat illnesses in men and women in unique and appropriate ways which will mean better health outcomes for all.
